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Running head: GINGER AS ANTIEMETIC THERAPY
Comparing Alternative Treatment to Pharmacological Treatment: Ginger for Patients
Experiencing Chemotherapy Induced Nausea and Vomiting
Samantha A. Blais
University of New Hampshire
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GINGER AS ANTIEMETIC THERAPY
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Abstract
This review includes fifteen published articles, which examine the effectiveness of ginger with
patients receiving chemotherapy who experience chemotherapy induced nausea and vomiting
(CINV). Approximately thirty-six to sixty-three percent of patients will report nausea within the
first twenty-four hours of receiving treatment, including those who receive anti-emetic therapy as
prophylaxis (as cited in Lee & Oh, 2013). Side effects of the current prophylactic treatment of
CINV in addition to lack of full coverage of delayed nausea and vomiting indicate a need for an
alternative, effective, and non-toxic regimen (Heckler et al., 2012). Ginger has been observed to
produce similar physiological actions as 5-HT3 receptor antagonists, indicating further research
to fill the need for an alternative treatment for CINV. According to the studies examined in this
review, the majority of the data provided inconclusive information. Ginger as a more effective,
cost efficient, natural, and non-toxic therapy is not significantly useful in the reduction of CINV
symptoms that create threats to the health, wellbeing, and quality of life of patients and
ultimately requires further research.
Keywords: ginger, chemotherapy induced nausea and vomiting, anti-emetic therapy
GINGER AS ANTIEMETIC THERAPY
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PICO Question
In adult patients (18+) with cancer, receiving chemotherapy treatment, and experiencing
chemotherapy induced nausea and vomiting (CINV), how effective is ginger in both, preventing
and treating, chemotherapy induced nausea and vomiting in comparison to pharmacological antiemetics?
Background and Rationale
Chemotherapy has been utilized for the treatment of cancer since the 1940s, following
World War II. Over one hundred chemotherapy drugs exist in order to cure, control, or relieve
symptoms of the disease (American Cancer Society, 2013). Chemotherapy has noticeably
improved the overall survival of many patients with various forms of cancer. However,
associated adverse effects produced by chemotherapy threaten the efficacy of treatment.
Chemotherapy induced nausea and vomiting (CINV) is among one of the most notorious and
intrusive adverse effects of chemotherapy regimens (Lee & Oh, 2013). In patients receiving
chemotherapy, anywhere from thirty six to sixty three percent of patients will report nausea in
the first 24 hours after receiving treatment, which includes those who are receiving anti-emetic
therapy as prophylaxis (as cited in Lee & Oh, 2013). CINV has been correlated with
complications, such as weakness and malnourishment that ultimately disturb the quality of life
and treatment outcome of patients receiving chemotherapy (Navari, 2013). According to Marx et
al. (2013), CINV causes malnourishment during treatment and may be seen in one of every two
patients, which can be linked to fatigue, poor response to treatment, or even the discontinuation
of treatment.
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Nausea and vomiting originate through an influx of neurotransmitters that bind to 5-
hydroxytryptamine 3 (5-HT3) and Neurokinin 1 (NK1) receptor sites when toxic substances,
such as chemotherapy, stimulate or damage cells within the body. Stimulation creates a signal
that is delivered to the chemoreceptor trigger zone (CTZ) and then to the vomiting center (VC)
of the medulla. Following this transmission, nausea and subsequent emesis occur in order to
attempt to clear the toxin from the system (Navari, 2013). Anti-emetics are responsible for
inhibiting 5-HT3 and NK1 receptor sites, which are normally activated by chemotherapy agents,
in order to halt the protective mechanism of the body.
To combat CINV, anti-emetic medication such as 5-HT3 antagonists, NK1 receptor
antagonists, corticosteroids, and anti-anxiolytics are often prescribed and administered before
and after chemotherapy treatment (Fahimi et al., 2011). Although anti-emetics perform a major
role in the endurance of chemotherapy, they also produce adverse reactions such as,
extrapyramidal effects, headaches, and constipation. In other circumstances, anti-emetic agents
fail to control acute nausea, which occurs within twenty-four hours of chemotherapy
administration, or delayed nausea, which occurs at twenty-four hours and up to five days after
chemotherapy (Heckler et al., 2012). Delayed nausea and vomiting are serious matters that
influence the continuation of treatment and the quality of life for patients. Currently, delayed
nausea and vomiting are poorly controlled by anti-emetic regimens and threaten outcomes of
patients receiving chemotherapy and experiencing CINV (Heckler et al., 2012).
The lack of adequate control of CINV indicates a need for an alternative, cost efficient,
non-toxic, and beneficial treatment option. Ginger, otherwise known as, Zingiber officinale, has
been acknowledged for centuries as an approach to relieve nausea and vomiting in areas such as,
motion sickness, pregnancy induced nausea, and postoperative nausea and vomiting (Haniadka,
GINGER AS ANTIEMETIC THERAPY
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Rajeev, Palatty, Arora, & Baliga, 2012). As an alternative to pharmacological therapy, ginger has
a low side effect profile, is cost efficient, has vast availability, and is hypothesized to provide
both acute and delayed nausea relief in patients receiving chemotherapy.
Search Methods
In order to conduct this review of research, Ebscohost was accessed through the
University of New Hampshire. The databases, CINAHL Complete, Cochrane Central Register of
Controlled Trials, and MEDLINE were utilized. The terms utilized in this search were “Ginger
for nausea and vomiting” and “Chemotherapy” with the addition of the Boolean phrase “AND”.
Additional specifications consisted of Linked Full Text articles only.
The inclusion criteria for this search were based on patients receiving chemotherapy for
treatment of cancer, 18 years or older, with a comparison of ginger to pharmacological treatment
for chemotherapy induced nausea and vomiting, systematic reviews were also accepted for
supplementation and knowledge acquisition. The search yielded eleven results, which all fit the
criteria, and were utilized. Specifically, six articles were systematic reviews, and five articles
were original research.
Upon completion of the initial search, the research was inconclusive regarding the
effectiveness of ginger. This led to an additional search through the references utilized in the
studies that had been initially examined. This was done to understand the research and factors
that originally influenced research for the use of ginger for anti-emetic effects in patients with
CINV. Three resources were derived from this search.
In addition to this search, I also took advantage of Google.com to supplement my
knowledge of chemotherapy. I searched “What is Chemotherapy”, which produced 37,500,000
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results. The American Cancer Society website, Cancer.org was utilized, which provided one
additional resource. This search produced a total of fifteen resources included in this review.
Critical Appraisal of the Evidence
In a review article by Rudolph M. Navari (2013), the pathophysiology of nausea and
vomiting, effectiveness of anti-emetic agents, and the clinical management of CINV are
explored. CINV is indicated as the major factor threatening the quality of life of patients
receiving chemotherapy. Although hypothesized to reduce CINV according to the
pathophysiology of ginger, Navari indicates a lack of supporting evidence to suggest ginger as a
treatment for nausea and vomiting. Additionally, there is an indicated lack of treatment for
delayed nausea and vomiting associated with CINV. Due to these findings, more research is
needed to identify the appropriate combinations for effective short and long-term control of
CINV.
In a systematic review and meta-analysis conducted by Lee and Oh (2013), a review of
five randomized, controlled trials indicates no significant evidence to suggest the control of
CINV by ginger supplementation in comparison to additional anti-emetic therapy. Although
inhibitory mechanisms of ginger are indicated by Abdel-Aziz et al. (2006), there was no concrete
data from this review to support those findings. Analysis of acute and delayed nausea control
through ginger supplementation in comparison to control groups were subsequently insignificant.
Due to the limited availability of meta-analysis, comparison and evaluation were difficult and
inconclusive. Limitations of this review included a small pool of available trials for evaluation.
Although inconclusive in terms of ginger’s effectiveness with CINV, the treatment was tolerable,
free of significant side effects, and offered a high adherence rate (Lee & Oh, 2013).
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Another systematic literature review conducted by Haniadka, Rajeev, Palatty, Arora, &
Baliga (2012), Ginger was observed as effective in the relief of acute nausea and vomiting.
Variability in most of the studies, led to the presence of insufficient data to draw a secure and
well-founded conclusion. In addition to reviewing the effectiveness of ginger, it’s mechanism of
action is included in this study. The compounds, gingerol, paradol, and shogaol, are components
of ginger that work as 5-HT3 and NK1 antagonists, with added antihistamine and prokinetic
gastrointestinal effects to theoretically reduce CINV (Haniadka, Rajeev, Palatty, Arora, &
Baliga, 2012).
As emphasized by, Haniadka, Rajeev, Palatty, Arora, & Baliga, the ratio of these
therapeutic compounds varies within ginger depending on it’s geographic location, age, and
method for preparation (Haniadka, Rajeev, Palatty, Arora, & Baliga, 2012). Due to this, a need
for research utilizing controlled ginger may produce sufficient effects without variability. In
conclusion, ginger as a preventative and treatment method for CINV shows inconclusive data
and requires more research.
An additional contradictory study regarding the effects of encapsulated ginger as a
treatment method for CINV showed no difference in the severity of acute versus delayed CINV
(Zick et al., 2009). This study was conducted as a randomized double blind controlled study,
which included 162 patients split into three groups. One group received one gram of ginger, the
next received two grams of ginger, and the placebo group received an 5-HT3 antagonist
medication (Zick et al., 2012). Notable findings from this study include an increase of nausea
and vomiting side effects with patients receiving the higher dose of ginger while taking an
addition anti-emetic agent. Of the 162 patients, 58% reported acute or delayed nausea, 31 %
reported acute nausea and vomiting, and 25% reported delayed nausea or vomiting (Zick et al.,
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2012). These results provide evidence to suggest a lack of control for delayed nausea and
vomiting especially with concomitant use with anti-emetic agents. Of note, patients were also
able to decipher the treatment they received due to the obvious taste of the ginger capsule. The
lack of blinding and small sample size reduced the reliability and generalizability of the research.
A mixed model analysis involving 576 patients studied the effectiveness of ginger on
CINV via dose separation (Heckler et al., 2012). The participants in this particular study were
divided into four groups receiving set doses of ginger. In comparison to placebo anti-emetic
medication, one half to two grams of ginger significantly reduced acute nausea in patients who
had experienced CINV in the past with chemotherapy administration (Heckler et al., 2012).
Data revealed that significant reduction of nausea was acknowledged on the first day of
chemotherapy, however, days two, three, and four showed weakened effectiveness of the ginger
treatment (Heckler et al., 2012). This study revealed the existence of anticipatory nausea as a
factor in CINV development, which may have negatively altered the effectiveness of ginger.
Some weaknesses and limitations that were acknowledged included lack of delayed nausea
relief, and small effect size for nausea (Heckler et al., 2012).
In a systematic literature review, which analyzed fourteen studies to compare the
effectiveness of ginger for patients experiencing CINV, one to two grams of ginger reduced the
severity of both acute and delayed CINV in thirty seven to forty seven percent of patients (Marx
et al., 2013). Specifically, doses of one half to one gram of encapsulated ginger, exhibited the
most effective range of acute and delayed nausea relief (Marx et al., 2013). In comparison to
metoclopramide, ginger was equally effective in reducing the delayed phase of CINV. Although
equally effective, ginger lacked the extrapyramidal side effects experienced by those taking
metoclopramide, which amplified support for ginger supplementation in lieu of metoclopramide.
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For the seven random controlled trials analyzed in this review, five produced positive
results regarding ginger. Three of the five studies, reported improvement when in combination
with a standard anti-emetic, while two identified improvement in acute and delayed nausea
(Marx et al., 2013). These positive results concurrently show a reduction of CINV by 16-47%
with ginger supplementation, which was statistically significant (Marx et al., 2013). Ginger is
still only a possible contender for CINV control, because more studies are needed in order to
produce solidified evidence to recommend its use in lieu of other pharmacological therapies.
Uncertainty in this area allows for the treatment option to be chosen by professional opinion
rather than anti-emetic guideline recommendation (Marx et al., 2013).
In a randomized, crossover, double-blind study a random assignment of ginger,
metoclopramide, or odansetron were administered to three groups of participants over the course
of three cycles of chemotherapy (Sontakke, Thawani, & Naik, 2003). Each cycle was separated
by twenty-one days. In particular, the groups that received ginger were administered 1000 mg
ginger, twenty minutes before chemotherapy, and six hours after chemotherapy (Sontakke,
Thawani, & Naik, 2003). At the conclusion of this study, after each group of participants
endured each cycle of anti-emetic therapy, the results indicated a complete control of nausea in
68% of participants receiving ginger; sixty-four percent receiving metoclopramide; and 86%
receiving odansetron (Sontakke, Thawani, & Naik, 2003). According to these results,
odansetron provided the most statistically significant management of CINV over the use of
ginger.
During a randomized, double blind, crossover study involving forty-eight patients
receiving cisplatin chemotherapy, patients were split into two groups to receive two different
regimens of anti-emetic therapy (Manusirivithaya et al., 2004). On the first day, standard anti-
GINGER AS ANTIEMETIC THERAPY
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emetics were administered to the participants, the group then split into two groups. One group
received one gram of ginger root powder in a capsule for five days, while the other group
received a placebo on the first day, but was switched to metoclopramide for three days.
Following the completion of a four-day cycle, each group switched to the other regimen in
crossover fashion.
There were no statistically significant difference between acute and delayed nausea and
vomiting experienced by participants (Manusirivithaya et al., 2004). One significant factor that
promoted the use of ginger was related to the comparison of side effects. Metoclopramide
produced headaches and restlessness, while ginger did not produce any significant side effects
(Manusirivithaya et al., 2004). This finding indicated the importance of continued research with
larger sample sizes to generalize the evidence.
In a study by Levine et al. (2006), twenty-eight patients receiving chemotherapy were
instructed to ingest one gram of encapsulated ginger root to monitor its anti-emetic effect. As a
comparison, protein was also added to the regimen. Two protein groups were created; one group
was considered low protein and one considered high protein. The two groups were administered
in combination with encapsulated ginger root (Levine et al., 2006). In addition, the control
group only monitored the effects of a protein diet. At the conclusion of the study, ginger root in
combination with the high protein diet decreased delayed nausea and vomiting in comparison to
the control group (Levine et al., 2006). Although results were significant, there were limitations
to this study. First, the ginger was not controlled to monitor the direct effect of the ginger. In
addition, the effect size is small and the study lacks the ability to be generalized to large
populations indicating a requirement for additional studies that involve larger participant groups.
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In a random crossover double-blinded study, comparing oral ginger to standard antiemetic treatment, no significant beneficial effect was experienced (Fahimi, 2011). Ginger was
given in four doses of 250 mg per day versus a placebo dose of a 5-HT3 or corticosteroid to
control CINV in patients receiving cisplatin as an anticancer regimen. When ginger is added to
the anti-emetic regimen, no improvements in the prevalence, severity, or duration of acute and
delayed nausea and vomiting are observed. This study was limited due to the inability to
decipher the effects of ginger as a lone treatment for CINV as it was added to the anti-emetic
regimen. In addition, limitations regarding the doses of study medication led to the possibility of
compliance issues. Due to the lack of evidence no significant beneficial effects of ginger on
CINV are reported, therefore more studies are required for the use of ginger in anti-emetic
guidelines.
In an article by Abascal and Yarnell (2009), the use of ginger for the treatment of CINV
was explored and discussed. As indicated in the article, digestive stimulation, headache relief,
and vasodilation are additional effects that have been observed in clinical trials (Abascal &
Yarnell, 2009). Digestive stimulation is linked to the notion that ginger provides relief from
nausea and vomiting in patients receiving chemotherapy. Results of a review of studies related
to ginger for the relief of CINV, indicate conflicting results that limit the use of ginger in the
clinical setting (Abascal & Yarnell, 2009). Positive aspects of ginger that make it a worthy
subject to continue to research are the digestive stimulation, headache relief, cardiac
vasodilation, and synergistic effects on botanical formulas (Abascal & Yarnell, 2009).
Finally, in contrast to the multiple inconclusive research studies indicated in this review,
Alparslan et al. (2009) examined the effectiveness of ginger versus anti-emetic drugs with
evidence of the effectiveness of ginger. In this study, there were no incidences of nausea and
GINGER AS ANTIEMETIC THERAPY
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vomiting for those receiving ginger whereas 76.7% of patients receiving anti-emetic drugs
experienced nausea and vomiting after chemotherapy (Alparslan et al , 2009). These results
provided statistically significant results that Limitations of this study consists of a small sample
size of thirty control group participants and eleven intervention group participants (Alparslan et.
al, 2009). The intervention group received 800 mg of ginger after chemotherapy whereas antiemetics were administered according to guideline standards (Alparslan et al, 2009). At the
conclusion of this study, results suggested the need for further research to be conducted for the
use of ginger to reduce CINV. This recommendation was attributed to the inequal samples in
each group of this study along with the small sample size and inability to generalize the data.
Evidence Synthesis
Ginger is hypothesized to be an alternative, low risk, and cheap method of nonpharmacological treatment of CINV. Malnourishment, weakness, and increased risk for
infection in many patients receiving chemotherapy indicate an importance for CINV control
(Navari, 2013). Current anti-emetic therapies have been successful in providing symptom relief
for acute nausea and vomiting, but are not as effective in controlling delayed nausea and
vomiting (Alparsian et al., 2009). This creates a deficiency in full coverage provided by the
current regimen for CINV control, indicating the need for an alternative method of relief.
Although ginger seems to have the means of being an alternate source of CINV control, a review
of current research has conveyed inconsistent and inconclusive data. Although inconclusive,
there are consistent variables that require further research and manipulation to offer promising
advances towards verifying the use of ginger in the treatment of CINV. The research examined
in this review provides evidence that suggests that ginger has beneficial effects for patients
receiving chemotherapy, ginger has a mechanism of action similar to anti-emetic agents, and
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variations in the research require more specified and controlled research to develop a viable and
significant treatment option (Walstab et al., 2013; Abdel Aziz, Windeck, Ploch, & Verspohl,
2006; Haniadka, Rajeev, Palatty, Arora, & Baliga, 2012; Alparsian et al., 2009).
Ginger is said to improve digestive stimulation and antagonize 5-HT3 receptors, which
are responsible for the stimulation of the chemoreceptor trigger zone and vomiting center of the
brain. In addition to these anti-emetic components, ginger has also been observed to produce
headache relief, vasodilation, anti-inflammatory, antimicrobial, and anti-lypidemic results, which
offer additional benefits to patients receiving chemotherapy (Alparsian et. al.,2009; Abascal &
Yarnell, 2009). In addition to physical benefits, ginger is abundant, cheap, and non-toxic
(Haniadka, Rajeev, Palatty, Arora, and Baliga, 2012). These factors are attractive and influence
the research of ginger in order to explore alternative, low risk, and cost efficient uses for ginger
in the treatment of CINV in lieu of current pharmacological therapies.
In addition to providing additional physical and economic benefits, ginger has been
observed to have a similar mechanism of action to pharmacological anti-emetic treatments
currently used for CINV. In three of the studies reviewed, ginger has been observed as a
compound that inactivates the 5-HT3 receptors responsible for nausea and vomiting influenced
by chemotherapy (Walstab et al., 2013; Abdel-Aziz, Windeck, Ploch, & Verspohl, 2006;
Haniadka, Rajeev, Palatty, Arora, & Baliga, 2012). Due to these findings there is a window of
suspicion regarding the possibility of ginger as an effective treatment for CINV. However,
Haniadka, Rajeev, Arora, and Baliga (2012), indicate a variability of the therapeutic effects of
ginger, which have been observed to change effectiveness depending on geographic location of
harvest, age when harvested, and the method utilized to extract and prepare the ginger. The
inconclusive data presented in this review is a possible result of this observation.
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There are many reasons to desire ginger as an alternative anti-emetic therapy to be
utilized for the treatment of CINV. However, this review ultimately produced a lack of
significant evidence to imply the recommended use of ginger in lieu of current anti-emetic
treatment for patients with CINV. Of the fifteen articles examined, eleven were applicable to the
direct use of ginger in comparison to other pharmacological therapies and ten of these eleven
studies indicated inconclusive data regarding ginger effectiveness in comparison to
pharmacological anti-emetics. Although inconclusive, the studies produced results that may
determine the route of future research.
An important area that requires further research to examine the effectiveness of ginger is
related to dosing. As indicted in four of the eleven studies, one half to one gram of ginger
proved to be the most effective dosage range for controlling acute CINV (Marx et al., 2013;
Fahimi et al., 2011; Ryan et al., 2012; Lee & Oh, 2013). Due to the small effect sizes exhibited
in the studies conducted by Ryan et al.(2012), and Fahimi et al. (2011), two studies elicited
conclusive evidence regarding the effectiveness of ginger on acute nausea and vomiting after
dosing between one half and one gram of ginger in patients receiving chemotherapy. Research
by Marx et al. (2013) identified that ginger was effective within the range of one half to one
gram of ginger, but without a significant difference in effectiveness than anti-emetic medication.
The effectiveness of ginger measured in the eleven studies reviewed in this article shows
effectiveness in mainly the acute stage of nausea and vomiting. However, the ability to control
delayed nausea and vomiting is of utmost importance as it is an area that degenerates the quality
of life of patients receiving chemotherapy. Delayed nausea and vomiting is the route of
malnourishment and secondary complications. One study by Alparsian et al. (2009) produced
significant data to suggest the effectiveness of ginger in lieu of anti-emetic therapy for patients
GINGER AS ANTIEMETIC THERAPY
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experiencing acute, but not delayed, CINV. Though significant evidence had been generated, the
overall quality of life and CINV of the patient was ultimately unattained by the administration of
ginger. Findings to support the effectiveness of ginger in treating CINV and the overall quality of
life of patients receiving chemotherapy are inconclusive. Due to this, ginger as an anti-emetic
therapy lacks the evidence to support motives for its use in the treatment of CINV in the place of
current recommended anti-emetic regimens.
Clinical and Research Recommendations
Considering a lack of strong and conclusive evidence to support the use of ginger in
decreasing CINV in comparison to current pharmacological anti-emetic therapies, continuing
research may be beneficial. Studies indicate that limitations in effect size, unspecified controls,
and larger sample sizes in order to explore all the options of ginger therapy in the reduction of
CINV (Marx et al., 2013; Ryan et al., 2012; Zick et al., 2009). In a study conducted by Levine
et al. (2006), data suggested a possible symbiotic use of ginger and protein for the
resolution/treatment of CINV. Since nausea and vomiting threatens the well being of
postoperative patients, antepartum patients, and patients suffering from motion sickness, the
observations of therapeutic agents such as ginger, with a similar mechanism of action as current
pharmacological therapies is still a topic worth studying (as cited in Alparsian et al., 2009;
Walstab et al., 2013; Abdel-Aziz, Windeck, Ploch, & Verspohl, 2006; and Haniadka, Rajeev,
Palatty, Arora, & Baliga, 2012).
In conclusion, the evidence produced by this review of ginger as an effective and
alternative anti-emetic therapy for patients experiencing CINV is inconclusive and clinically
insignificant. Due to this finding, the recommendations for treating patients with CINV will
continue to emphasize pharmacological anti-emetics such as 5-HT3 receptor antagonists and
GINGER AS ANTIEMETIC THERAPY
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NK1 receptor antagonists. Before a national recommendation can be created in regard to the use
of ginger for CINV in the clinical setting, more research has to be conducted. Therefore, nurses
must be aware of this clinical ineffectiveness and educate their patients about the lack of
significant effectiveness produced by ginger for CINV relief if they request ginger in lieu of antiemetics.
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References
Abascal, K., and Yarnell, E. (2009). Clinical uses of Zingiber officinale (ginger).
Alternative & Complementary Therapies, 15(5), 231-237.
Abdel-Aziz, H., Windeck, T., Ploch, M., and Verspohl, E. J. (2006) Mode of action of gingerols
and shogaols on 5-HT3 receptors: Binding studies, cation uptake by the receptor channel
and contraction of isolated guinea-pig ileum. European Journal of Pharmacology. 530,
136–143.
Alparslan, G. B., Ozkarman, A., Eskin, N., Yilmaz, S., Akay, M., Acikgoz, A., and Orsal,
O. (2012). Effect of Ginger on Chemotherapy-Induced Nausea and/or Vomiting in
Cancer Patients. Journal Of The Australian Traditional-Medicine Society, 18(1), 15-18.
American Cancer Society. (2013). What is Chemotherapy?. The American Cancer
Society. Retrieved from:
http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/chemotherapy/
chemotherapyprinciplesanindepthdiscussionofthetechniquesanditsroleintreatment/chemotherapy-principles-what-ischemo
Fahimi, F., Khodadad, K., Amini, S., Naghibi, F., Salamzadeh, J., and Baniasadi, S. (2011).
Evaluating the effect of zingiber officinalis on nausea and vomiting in patients receiving
Cisplatin based regimens. Iranian Journal Of Pharmaceutical Research: IJPR, 10(2),
379-384.
Haniadka, R., Rajeev, A. G., Palatty, P. L., Arora, R., and Baliga, M. S. (2012). Zingiber
officinale (Ginger) as an anti-emetic in cancer chemotherapy: A review. Journal Of
Alternative & Complementary Medicine, 18(5), 440-444. doi:10.1089/acm.2010.0737
GINGER AS ANTIEMETIC THERAPY
18
Lee, J., and Oh, H. (2013). Ginger as an antiemetic modality for chemotherapy-induced nausea
and vomiting: A systematic review and meta-analysis. Oncology Nursing Forum, 40(2),
163-170. doi:10.1188/13.ONF.163-170
Levine, M., Gillis, M., Koch, S., Voss, A., Stern, R., and Koch, K. (2008). Protein and ginger for
the treatment of chemotherapy-induced delayed nausea. Journal Of Alternative &
Complementary Medicine, 14(5), 545-551. doi:10.1089/acm.2007.0817
Manusirivithaya, S., Sripramote, M., Tangjithamol, S., Sheanakul, C., Leelahokorn, S.,
Thavaramara, T., and Tangcharoenpanich, K. (2004). Antiemetic effect of ginger in
gynecologic oncology patients receiving cisplatin. International Journal of
Gynecological Cancer. 14 (6), 1063-1069.
Marx, W. M., Teleni, L., McCarthy, A. L., Vitetta, L., McKavanagh, D., Thomson, D., and
Isenring, E. (2013). Ginger ( Zingiber officinale) and chemotherapy-induced nausea and
vomiting: a systematic literature review. Nutrition Reviews, 71(4), 245-254.
doi:10.1111/nure.12016
Navari, R. (2013). Management of Chemotherapy-Induced Nausea and Vomiting. Drugs, 73(3),
249-262. doi:10.1007/s40265-013-0019-1
Ryan, J., Heckler, C., Roscoe, J., Dakhil, S., Kirshner, J., Flynn, P., and Morrow, G. (2012).
Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: A URCC
CCOP study of 576 patients. Supportive Care In Cancer, 20(7), 1479-1489.
doi:10.1007/s00520-011-1236-3
Sontakke S., Thawani V., and Naik M. S. (2003) Ginger as an antiemetic in nausea and vomiting
induced by chemotherapy: a randomized, cross-over, double-blind study. Indian Journal
of Pharmacology. 35, 32–36
GINGER AS ANTIEMETIC THERAPY
19
Walstab, J., Krüger, D., Stark, T., Hofmann, T., Demir, I. E., Ceyhan, G. O., and Niesler, B.
(2013). Ginger and its pungent constituents non-competitively inhibit activation of
human recombinant and native 5-HT3 receptors of enteric neurons. The Official Journal
Of The European Gastrointestinal Motility Society, 25(5), 439. doi:10.1111/nmo.12107
Zick, S., Ruffin, M., Lee, J., Normolle, D., Siden, R., Alrawi, S., and Brenner, D. (2009). Phase
II trial of encapsulated ginger as a treatment for chemotherapy-induced nausea and
vomiting. Supportive Care In Cancer, 17(5), 563-572. doi:10.1007/s00520-008-0528-8